Critique and Analysis of Family Stress Theory

Critique and Analysis of Family Stress Theory

Because nursing relies on continuous research and advancement in the field of medicine to better meet the needs of our patients, it is critical to understand the function and purpose of theories as they exist. The Family Stress Theory is a model aimed at understanding the relationship between the presence or absence of coping mechanisms in stressful situations that can lead to a family’s crisis and how the family responds to the crisis. Hill’s model considers the experience of dealing with acute stressors (those that occur suddenly in nature) that, if accumulated, can lead to family crises such as physical, emotional, or relational crises. Domestic violence, substance abuse (relapses), illness from weakened immune systems, divorce, accidents, and children being abused or neglected are all examples of family crises caused by family stressors.

This paper will examine the components of Hill’s Family Stress Theory and how this model can help a family when the nursing process takes a family’s stress and coping mechanisms into account. This paper will also identify techniques for using the model in the assessment of the family unit.

Theory of Family Stress

Dr. Ruben Hill, a theorist, developed the Family Stress Theory in the late 1940s. On July 4, 1912, Dr. Reuben Hill was born. He received his B.S. in 1935, a Master’s degree in 1936, and Ph.D. in 1938. Dr. Hill became a sociology professor at the University of Minnesota in 1957. Dr. Hill was a world-renowned expert on marriage and families, specializing in family problem-solving and crisis adjustment.

In addition, he was named director of the Minnesota Family Study Center, a facility that will help graduate students study family relationships with their research. Dr. Hill also served as a member and consultant for over 50 organizations, including the American Sociological Association, the Social Security Administration, the American Association for the Advancement of Science, and the International Sociological Association, of which he was president (1970-1974). Dr. Hill was named Regents’ Professor in 1973, the highest honor bestowed upon the faculty at the University of Minnesota. Dr. Hill died on September 21, 1985, after retiring as Regents’ professor emeritus in 1983.

Important Ideas

Previous research on stress has suggested that in order to initiate the coping and adaptation response, the significant characteristics of the stressors must be identified. Changes in daily routines, the number of changes that may occur in a daily routine, and the length of time since the last change in daily routines are some of the more common stressor characteristics. The impact of the stressor, however, can be mitigated or buffered by protective measures that assist families in surviving multiple contextual stressors and continuing to competently make positive healthcare decisions despite chronic and acute stressors.

Sroufe and Fleeson (2008) sought to identify the two basic protective measures proposed by Hill as buffers to lessen the impact of stressors. Hill went on to develop the ABCX model as a framework for identifying stressors and their characteristics, the family’s available resources and perceptions for dealing with and responding to the stressor, and the overall crisis. In Hill’s ABCX framework, the “A” variable defines the stressors that occur at any given time. Hill identified two additional factors: social relationships and family support structures (“B” variable) and perceptions of the degree of stress caused by the actual stressor (“C” variable).

Social relationships (“B” variables) are distinguished further as belonging to family variables such as attachment level, positive family bonding, and effective communication techniques. Social isolation may occur in social relationships across family variables, regardless of informal or formal social support networks. The perceptions of the family (“C” variable) may include a range of cognitions and attitudes ranging from hope and personal effectiveness to a family’s sense of despair and helplessness. These two complex factors can be used to predict a family in crisis, which is represented by the “X” variable, by correlating the presence of acute stressors and the ongoing social context of chronic stressors.

Hundreds of studies have found a positive link between illness and stress. Individuals who are exposed to too many stressors at once are more likely to suffer negative outcomes. According to Sroufe and Fleeson (2008), the family unit has an increased risk factor for returning to a state of crisis in relation to having a debilitating accident, becoming physically ill, exhibiting signs and symptoms of an impaired immune system, becoming violent, or relapsing into a downward spiral in relation to illicit drug or alcohol abuse within a one-year time frame. Individuals and families who experience too many stressors at once are more likely to experience aggravated family crises. However, not ALL families dealing with multiple stressors have gone through a crisis. Some families have experienced crises in the past and now have a renewed sense of hope, allowing the family unit to cope with change and adaptation in a healthier way.

Assumption of Family Stress Theory Regarding Family and Nursing

Hill developed the Family Stress Theory, a middle-range theory that recognizes family variability through research. According to Wilmoth and Smyser (2009), Hill’s Family Stress Theory helps to define why some families can cope with stressful situations while others cannot. Families that are unable to cope with these situations may become even more stressed as a result of the crisis.

Stressful events can bring the family unit to its knees. Some of these stressors are either normative or non-normative in nature. Normative stressors, according to Wilmoth and Smyser (2009), are those that are considered a normal occurrence in life, such as a child starting school for the first time. McCubbin and McCubbin expanded on the Family Stress Theory’s assumption of a crisis family in 1996 (Smith & Liehr, 2008): Families face difficulties and changes throughout their lives as a natural and predictable part of family life. Non-normative stressors, on the other hand, are more unpredictable and can result in a crisis situation, such as job loss, a car accident that causes bodily harm, or the death of a loved one. Wilmoth and Smyser (2009) go on to say that the coping mechanisms of the family unit determine how a stressor is perceived. Those events that happen naturally and are allowed to happen within the family structure will be welcomed as a guiding force in dealing with the situation. Non-volitional stressors are events that occur over which one has no control, such as a tornado or an earthquake (Wilmoth & Smyser, 2009).

Any event that disrupts the families’ normal routine can result in a crisis. Every family will react differently to stressors and change, as will each member of the family unit. Families grow as a unit to support each member’s growth and development and to protect the family unit during times of crisis.

In the case of the family nurse, it is critical to understand Hill’s Family Stress Theory. This understanding can help the family nurse assess how the family functions as a unit in terms of identifying perceived stressors and how each member of the family reacts to the stressors. In turn, the family will have access to a network of healthcare professionals who will help guide the family unit through a stressful situation that has resulted in a family crisis. The family will also learn how to use the resources available in their communities and neighborhoods.

The goal for a crisis-affected family is to restore or maintain optimal health standards for their family unit. Nursing is responsible in the Family Stress Theory’s metaparadigm for assisting these families in the process of adaptation by promoting the family member’s health, assisting them to recover from illness, assisting the family member in functioning within the specific health limitation, supporting and developing the family’s strengths, assisting in the use of community resources available, facilitating the family in the appraisal of the situation, and helping the family decide what is best for them (Beckett, 2000).

In Family Nursing, the Family Stress Theory

Anyone or multiple relationships in the family can be affected by stress. Although stress is normal and natural in the family, extreme stress can lead to serious family problems such as domestic violence, alcoholism, substance abuse, and even child neglect. The way the family responds and thrives in a stressful situation determines the outcome of the family’s situation during the stressful event. A stressful event can be an acute or chronic illness in the family, sudden role changes in the midst of a death in the family, or hardships such as divorce or job loss. Hill’s theory implementation guides the family nurse to further investigate the family system’s behavior and response to situational stressors and transitional events that affect the family’s function.

The Family Stress Theory aided the family’s ability to cope with the care of a child with special needs (Crawford, 2002). A special needs child causes stress for both parents because it takes time to develop competency in caring for such a child in the family. To adapt to the crisis, the use of community and family resources should be offered and considered. One piece of literature also suggested that “remarriage and adjustment to stepfamily living are conceptualized as life transitions in the framework of the Family Stress Theory” (Crosbie-Burnett, 1989).

Identifying the variables present in any stressful event, as well as the family’s ability to adapt to the stress using all available resources, can help the family nurse set goals for the family unit and develop an individualized plan to help the family meet those goals. It is also the family nurse’s responsibility to educate the family on possible interventions that can be implemented to improve the family’s coping mechanisms when faced with a crisis. The nurse is also in charge of following up on the intervention and evaluating its effectiveness in order to either continue with the current management or change the coping strategy. In this regard, the family nurse continues to use core nursing concepts to facilitate and enhance the knowledge of the family unit in order to address future incidents that may lead to crisis situations.

Family Evaluation

In order to apply evidence-based research to the family’s goals and plan of care, one should look to use data collected from quantitative and qualitative research studies when assessing the family unit. According to Freidman et al. (2003), the assessment of the family unit should include an evaluation of their resources and coping strategies in order to provide appropriate assistance in adaptation and attainment of a higher level of wellness. When faced with a stressful event, families employ various management and coping strategies. The nurse will need to assess whether the family is healthy or dysfunctional. During the assessment period, the nurse established specific goals to assist the family in developing stress-coping mechanisms. Family support, financial resources, and coping strategies will serve as the foundation for achieving the goals. Even in the midst of the current economic crisis, families remain strong and resilient. Despite all economic, social, and political pressures, most families are functioning satisfactorily (Friedman et al., 2003).

The theoretical model of family stress identifies two types of situations that can lead to a family crisis. These events are classified as developmental and situational. Developmental events are those that are identified as a family’s psychosocial growth. Retirement, a child starting high school or college, or adoption are some examples. The examples depict the typical life cycle that affects the entire family unit. Unexpected events, such as death, job loss, or the loss of a home due to a fire, are considered situational events. The family’s financial resources and coping mechanisms will aid in adaptation and crisis resolution. The nurse can use the examples provided to assist the family in developing goals for becoming a healthy and strong family again.

Family Stress Theory: A Critique

The Family Stress Theory can be used to create care plans that improve the effectiveness of outcomes for positive family health. Family clinicians employ the Stress Theory to facilitate a collaborative learning process among family members, with a focus on the various family processes: parenting, balancing work, dealing with childhood issues, and maintaining home life stability. The Family Stress Theory can also be used to identify sources of stress, giving you a head start on developing strategic plans to help you manage them. The Stress Theory’s additional applicability provides a helpful resource for identifying individual family members’ coping mechanisms and determining how effective their coping strategies are during stressful family situations. Freidman et al. (2003) discovered that the framework for the Family Stress Theory could also be used to explain how families adjust and adapt as a unit during stressful events.

A cultural genogram can be used to gather information about the strengths and weaknesses of cultural families in order to identify coping mechanisms. The clinician applies the information to the Family Stress Theory framework to help the family develop feasible ways to deal with stressful events. Continued research efforts incorporating the Stress Theory are critical for developing innovative family care plans to assist families in avoiding and reducing stress levels. More family-centered research can be conducted to address the coping behaviors of culturally diverse families in stressful situations (Friedman et al., 2003). The new wave of multi-type families reinforces the need for intervention research that serves as evidence-based practices to assist not only culturally diverse families but all families, in dealing with stress.

Strengths

The Family Stress Theory of Hill has stood the test of time. Initially, Hill concentrated on post-Great Depression families with family members returning from World War II. The ABCX model depicts a clear breakdown of the reaction families take after a crisis, which is still relevant in assessing today’s families. Hill defined the patterns of reactions observed based on the reactions of individual family members as well as the reactions of the entire family.

The Family Stress Theory is a simple model that can be easily translated into therapy and interventions. This fact contributes to the theoretical framework’s strength. It is critical that families understand the system during the assessment period when explaining the model and how it relates to the family’s situational crisis. This is an opportunity for the family nurse to explain the premise of adaptation, family adaptation, family coherence, and family resilience. The role of the family nurse can help to translate how the model’s steps can be used during both therapy sessions and intervention processes. The family’s development will be accelerated, and the collaboration of the family nurse and the family unit will foster an environment based on predetermined goals in a collaborative effort.

According to Fine (1991), “personal perceptions and responses to stressful life events are critical elements of survival, recovery, and rehabilitation, often transcending reality or the interventions of others.” Hill’s theory has also served as the foundation for many other research studies on the stress and coping characteristics of family units. McCubbin et al., to name a few, are theorists who have all based their models in some way on Hill’s Family Stress Theory (Friedman et al., 2003).

Weaknesses

The relationship between the crisis and the resource is not examined in Hill’s Family Stress Theory. In response to a crisis, a family, for example, seeks the assistance of their church. Historically, the family rarely attended church and did not participate in activities other than attending service. In times of need, the family turns to their church, even though this may not be the best resource for the family unit. The church may have shown the family support, but it was not always the support they desired.

The focus on the pre-crisis stage is another weakness of Hill’s Family Stress Theory. The pre-crisis stage is critical because it is hoped that this period will lay the groundwork for education and the adaptation of coping mechanisms. Families, on the other hand, maybe relatively stress-free. A family does not need to enter crisis management mode until a major stressor occurs. If the family is not used to dealing with crises, they may be limited in providing pertinent information about the family’s adaptation and coping mechanisms as they relate to previous incidents of crisis or the interruption of the families’ needs because it has been some time since they have had to deal with a crisis situation. This is an important time because not all members will react the same way. If one family member is unable to cope with the stress and withdraws from the family, a new stress is created because this does not correspond to the family’s pre-crisis model. Based on the information provided, the family nurse can assist in goal setting. To return to the functional family unit that they once were, the family will need to engage in discussions and work sessions. Unexpected events can lead to a disorganized attempt to meet the family’s goals. If the process is not interrupted, the family nurse and the family can make progress.

Family Nursing Study

Family problems come in all shapes and sizes; some are brief and easily resolved, while others are chronic and difficult to manage. Willoughby et al. (2008) define stressors as events such as illness and injury, job changes, school changes, moving, and financial difficulties. Each family develops its own coping mechanisms, some of which work better than others.

Many studies on family stress have been conducted using the Family Stress Theory as a framework. Willoughby et al. (2008), in their article “Parental reaction to their child’s sexual orientation disclosure: A family stress perspective,” used the Family Stress Theory as a framework to understand parental reactions to their child’s sexual orientation disclosure and the impact of parental reactions on child and family development.

The Family Stress Theory was used as an observational approach to study relationships within the context of the family as they relate to their child’s sexual orientation acceptance or non-acceptance. Empirical evidence was reviewed to support the idea that parental reactions may be influenced by (1) the availability of family-based stress management resources, (2) the meaning attributed to the stressful event, and (3) the accumulation of co-occurring stressors taxing a family’s coping resources (Willoughby et al., 2008). There is also a discussion of empirical links between parental reactions and child outcomes.

The authors of this study discovered that the child who comes out to their parents about their sexual orientation initially face a difficult stressor. The parent’s initial reaction was negative, characterized primarily by a grief-like reaction (Willoughby et al., 2008). According to additional research, mother figures are more supportive than father figures. Based on the child’s positive or negative reaction to the stressor, the parental reaction plays an important role in his or her emotional and psychological well-being. During this time, parents’ assistance is critical. Younger parents have been found to be more accepting of their child’s sexual orientation than older parents (Willoughby et al., 2008). To summarize, Family Stress Theory suggests that a family’s reaction to their child’s sexual orientation will be heavily influenced by the family’s ability to deal with this stressor. The outcome will also be determined by whether or not the family is dealing with multiple stressors at the same time (Willoughby et al., 2008). In this case, theory and research indicate a strong relationship between parental reactions to stressors and the child’s ability to avoid these stressors becoming a crisis (Willoughby et al., 2008).

Future research should focus on the individual as well as family factors that promote or hinder parental acceptance of a child who identifies with the same sex orientation as a companion. Clinicians should consider increasing family-based resources by using cognitive-based approaches to modify parental attributions and reduce stressors that accumulate when working with same-sex families (Willoughby et al., 2008).

Each family has its own set of advantages and disadvantages, assets and liabilities, challenges, and problems. If a family appears to be overwhelmed with problems, or if relationships within the family have broken down, it is likely that extrinsic factors are needed to assist the family in dealing with stressors that could lead to a crisis. Even with additional support, some families may struggle to cope with life’s inevitable crises. In light of this, the family nurse should continue to support the family unit and set new goals on a regular basis in order to achieve a more harmonious family environment.

Conclusion

The Family Stress Theory can provide nurses with intrinsic as well as extrinsic information to help them provide better services, care, and outreach to families. The theory’s identified concepts and assumptions are currently being researched for efficiency in providing the best application measures for family nursing practice. Despite the weaknesses identified in theory, the theory’s strengths far outweigh the weaknesses.

Evidence-based practice (EBP) has become the gold standard for nursing care, treatment, and interventions in recent years. Walker and Avant (2011) cited the definition of EBP per Eisenberg (1998) as the “[method] that draws on the findings of research to provide information to improve patient care for each individual, while at the same time challenging researchers to address the questions for which clinicians and patients most urgently need information.” Finally, the family stress theory can not only be used to guide evidence-based practice nursing techniques in acute care settings, but it can also provide insight into primary prevention methods.

References

Beckett, C. (2000). Family theory as a framework for assessment. Unpublished manuscript, Northern Arizona University, Flagstaff, Arizona. Retrieved from http://jan.ucc.nau.edu/~nur350- c/class/2_family/theory/lesson2-1-3.html

Crawford, D. (2002). Keep the focus on the family. Journal of Child Health Care, 6, 133-146. doi: 10.1177/136749350200600201

Crosbie-Burnett, M. (1989, July). Application of Family Stress Theory to remarriage: A Model for assessing and helping stepfamilies. Family Relations, 38, 323-331. Retrieved from http://www.jstor.org/pss/585060

Fine, S. (1991). Resilience and human adaptability: Who rises above adversity? The American Journal of Occupational Therapy, 45(6), 493-503.

Friedman, M. M., Bowden, V. R., & Jones, E. G. (2003). Family Nursing: Research, Theory, and Practice (5th Ed.). Upper Saddle, NJ: Prentice-Hall.

Smith, M., & Liehr, P. (2008). Middle range theory for nursing (2nd ed.). New York, NY: Springer Publishing Company, LLC.

Sroufe, L. A., & Fleeson, J. (2008). The coherence of family relationships. In R. A. Hinde & J. Stevenson Hinde (Eds.), Relationships within families: Mutual parental responsiveness, and infant influences. Oxford: Oxford University Press, 27–47.

Walker, L. O., & Avant, K. C. (2011). Strategies for theory construction in nursing (5th ed.). Upper Saddle River, NJ: Pearson/Prentice Hall.

Willoughby, B., Doty, N., & Malik, N. (2008). Parental reactions to their child’s sexual orientation disclosure: a family stress perspective. Parenting: Science & Practice, 8(1), 70-91.

Wilmoth, J., & Smyser, S. (2009). The ABC-X model of family stress in the book of Philippians. Journal of Psychology and Theology, 37(2), 155-162.

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Marriage and the Family

Discussion Topic

Discuss how family stress differs from family crises. Relate ONE incident of stress and ONE crisis you or a family member have experienced in your own family.

At least 275 words. APA Format

Course Materials: Lamanna, Mary Ann, and Agnes Riedmann. Marriages and Families, 13th ed. Cengage, 2018.ISBN: 978-128573697-6